Vancomycin infusion reaction

topic review and case report

Abstract

Introduction: Although widely used as an alternative for surgical antibiotic prophylaxis in allergic patients to penicillin, the use of vancomycin can carry significant risks, such as a vancomycin infusion reaction that can be confused with an anaphylactic reaction. This case report and review of the topic are highly relevant to the daily practice of anesthesiologists. Case report: An ASA 1 15-year-old male patient undergoing laparoscopic cholecystectomy received vancomycin as antibiotic prophylaxis due to a history of penicillin allergy. During the infusion, he presented with a skin rash, hypotension, and tachycardia. After the medication was discontinued and an antihistamine was administered, the symptoms were resolved, and the surgical procedure and subsequent discharge from the postanesthesia care unit occurred without any incidents. Discussion: Vancomycin infusion reaction is a non-IgE mediated event primarily associated with rapid drug infusion. The symptoms can mimic an anaphylactic reaction, with the main difference being that this is IgE-mediated. The reported case reinforces the importance of early recognition and management of the condition, as well the discussion about the real need to change surgical antibiotic prophylaxis in patients with a history of penicillin allergy, which can lead to unnecessary changes and compromise effective antimicrobial coverage.